Lakeview Manor - Weyauwega Nursing Home
General Information
UPDATEFederal Provider Number
525698
Provider Name
LAKEVIEW MANOR
Provider Address
912 MANOR DRIVE
WEYAUWEGA, WI 54983
WEYAUWEGA, WI 54983
Provider Phone Number
(920) 867-2183
Provider SSA County
670
Provider County Name
Waupaca
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
50
Number of Residents in Certified Beds
38
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTY OF WAUPACA
Date First Approved to Provide Medicare and Medicaid services
2009-06-22
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.92237
Reported LPN Staffing Hours per Resident per Day
0.31447
Reported RN Staffing Hours per Resident per Day
0.99342
Reported Licensed Staffing Hours per Resident per Day
1.30789
Reported Total Nurse Staffing Hours per Resident per Day
4.23026
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00921
Expected CNA Staffing Hours per Resident per Day
2.43979
Expected LPN Staffing Hours per Resident per Day
0.60322
Expected RN Staffing Hours per Resident per Day
0.85626
Expected Total Nurse Staffing Hours per Resident per Day
3.89927
Adjusted CNA Staffing Hours per Resident per Day
2.93903
Adjusted LPN Staffing Hours per Resident per Day
0.43270
Adjusted RN Staffing Hours per Resident per Day
0.86689
Adjusted Total Nurse Staffing Hours per Resident per Day
4.37306
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-07-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-07-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
52
Cycle 3 Standard Health Survey Date
2012-06-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
52
Total Weighted Health Survey Score
17.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
0
Total Number of Penalties
0
Location
Processing Date
2015-06-01
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